Adherence to the Revised Malaria Treatment Guideline by Prescribers in Health Facilities in the La Nkwantanang-Madina Municipality

Abstract

Although malaria is a preventable, it still remains a major public health problem worldwide, particularly in sub-Sahara Africa where it is associated with high morbidity and mortality especially in pregnant women and children under five. Due to resistance to monotherapy, in 2004 Ghana employed the Artemisinin-based Combination Therapy (ACT) as first line treatment policy which was also revised in 2014. The revised treatment guideline makes provision for surveillance which helps track management of malaria cases for early identification of potential emergence of drug resistance. Despite Ghana’s adoption of the malaria guideline and conducting series of training for health professionals including prescribers but, morbidity and mortality due to malaria still remains unacceptably high. The study sought to assess prescriber adherence to the revised malaria treatment guideline in health facilities in the La-Nkwantanang Madina Municipality. Method A cross sectional study was conducted in ten health facilities in the La-Nkwantanang Madina Municipality in Accra within the second quarter of 2017. Data collection methods employed included interviews and extraction of data from health facility records and interviewing prescribers. Data were edited, cleaned, coded in Microsoft excel and analyzed using the Stata version 15. Simple descriptive statistics, frequencies, proportions and means of variables were computed. Bivariate analysis was done to show associations between selected independent variables and outcome variable. Factors predictive of prescriber adherence to the guideline were determined by multivariate analysis at a 0.05 significance level and a 95% confidence interval. Results Four hundred and thirteen patient health records (413) from 10 health facilities with different level of care were used in the analysis. Of the 413 patient health records reviewed 87.7% (362/413) patients were tested for confirmation of malaria before treatment was given, whereas 12.3% (51/413) patient received presumptive treatment. Positive cases were 32.60% (118/362), however 56.42% (234/413) patients were prescribed ACT. For patients who received ACTs 48.50% had positive test results, 29.61% had negative test results and 21.79% were presumed cases. The proportion of patient health records in which prescribers adhered with guideline was 61.72% (255/413). However, overall prescriber adherence was poor 28.6%. Prescriber trained in case management (UOR = 6.01, 95% CI =4.16-12.6, p<0.001) history of fever, (AOR: 3.88 95% CI: 1.43 – 10.50, p<0.008), facility type, (AOR: 1.68, 95% CI: 0.20 – 4.26, p<0.008) and female prescribers (UOR = 5.87, 95% CI = 1.01, 34.02, p=0.048) had a positive influence on prescriber adherence. Conclusions Overall, prescriber adherence was poor (28.6%), however testing for malaria parasite was high (87.65%). Patients who tested negative were prescribed ACT coupled with presumptive treatment. There was poor documentation of patient assessment performed. Prescriber adherence was higher among female prescribers, patient without history of fever, facility type and those who have been trained on the malaria treatment guideline.